5/15/2019 1 Targeted Herbs, Flower Essences for PTSD a psychogenomic approch Dr. Elissa Mendenhall, ND Director, Amenda Clinic What Is PTSD? DSM Criteria Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: •1. Directly experiencing the traumatic event(s). •2. Witnessing, in person, the event(s) as it occurred to others. •3. Learning that the traumatic event(s) occurred to a close family member or close friend. •4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (eg, first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
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Targeted Herbs, Flower Essences for PTSD
a psychogenomic approchDr. Elissa Mendenhall, ND
Director, Amenda Clinic
What Is PTSD? DSM Criteria
Exposure to actual or threatened death, serious injury, or sexual violence in
one (or more) of the following ways:
•1. Directly experiencing the traumatic event(s).
•2. Witnessing, in person, the event(s) as it occurred to others.
•3. Learning that the traumatic event(s) occurred to a close family member
or close friend.
•4. Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (eg, first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
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What Is PTSD? DSM Criteria
One or more of the the following symptoms:
•1. Recurrent, involuntary, and intrusive distressing memories of the
traumatic event(s).
•2. Recurrent distressing dreams in which the content and/or affect of the
dream are related to the traumatic event(s).
•3. Dissociative reactions (eg, flashbacks).
•4. Intense or prolonged psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the traumatic
event(s).
•5. Marked physiological reactions to internal or external cues that
symbolize or resemble an aspect of the traumatic event(s).
What Is PTSD? DSM Criteria (cont)
C. Persistent avoidance of stimuli associated with the traumatic event(s) including:
•1. Avoidance of or efforts to avoid related distressing memories, thoughts, or feelings.
•2. Avoidance of or efforts to avoid related reminders that arouse distressing memories, thoughts, or feelings.
D. Negative alterations in cognitions and mood associated with the traumatic event(s), examples:
•1. Inability to remember an important aspect of the traumatic event(s).
•2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world, for example:
-"I am bad’’, "No one can be trusted’’, "The world is completely dangerous,” "My whole nervous system is permanently ruined"
•3. Blaming self or others.
•4. Persistent negative emotional state (eg, fear, horror, anger, guilt, or shame).
•5. Markedly diminished interest or participation in significant activities.
•6. Feelings of detachment or estrangement from others.
•7. Persistent inability to experience positive emotions.
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What Is PTSD? DSM Criteria
E. Marked alterations in arousal and reactivity associated with the traumatic
event(s), such as:
•1. Irritable behavior and angry outbursts typically expressed as verbal or
physical aggression toward people or objects.
•2. Reckless or self-destructive behavior.
•3. Hypervigilance.
•4. Exaggerated startle response.
•5. Problems with concentration.
•6. Sleep disturbance (eg, difficulty falling or staying asleep or restless
Tea – strong cup 1-2 times a day. Infused 3-5 minutes, 1-2 Tbsp per 1 cup water.
Tincture - ½ dropperful – 2 dropperful as needed for anxiety or sleep, or daily for prevention of anxiety, or seizures.
Capsules 100mg – 350mg dried herb per day (freeze-dried herb)
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Scutellaria lateriflora
Special Characteristics
Synergy
Works well in formulas
Often studied as part of a formula
Thought to potentiate actions of other herbs
Nerve tonic.
Tonic, not rescue
Nutritive and safe
Neutral to warm, sweet
Milky oats
Avena sativa - Profile
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Insomnia from chattery mind
Being snappy from exhaustion or depletion
Feeling easily scattered
Heart palpitations
“nervous dyspepsia”
Useful in addiction formulas
Wired and tired, driven people
Avena – indications
Generally well-tolerated
Celiac – debated.
Avena - precautions
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Tea or tincture from fresh tops
Can be used in “material” or “drop” doses
1-2 dropperfuls 1-3 times a day OR
7-10 drops prn
Avena - dosage
Nothing in the Natural Medicines database per anxiety or as a nervine.
Herbal folk tradition
Sources: Henriette’s Herbal, The Earthwise Herbal by Matthew Wood,
Medicinal and Medicinal Plants of the Desert and Canyon West by Michael
Moore
Avena – evidence base
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Insomniac father
Never slept well since baby was born 6 years prior
Sleep latency 1-4 hours most nights
Startles on waking
Paradoxical response to Benadryl
Nonresponse to magnesium, Cortisol Manager, and melatonin, trazodone,
or Ambien
Magic formula – 1-2 gttful scutellaria, humulus lupus, and avena
Case – 36 yo male
Kava
piper methysticum
In the Piperaceae family
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Kava - indications
• Anxiety – GAD and other types of anxiety
• Insomnia – All types, especially when
chattering mind is a component
• Pain – Useful in fibromylagia. Nonopiate
mechanism. Antiinflammatory -
• Muscle tension – acts on GABA and
inflammation.
Can maintain cognitive function while using.
Anti-inflammatory – inhibits COX-1 and COX-2 enzymes
Anxiolytic effect not thoroughly understood. Does not bind to GABA-A
(BZD) receptors. Dopamine antagonism? Inhibits NE uptake?
Acts on amygdala and hippocampus
Standardized to kavalactones percentage.
Kava – mechanisms of action
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Impaired hepatic function – research controversial. 9g daily is considered a high dose which could be problematic. Consider monitoring hepatic function.
Anticoagulant effect – decreases aggregation of platelets
Adverse effects: gastrointestinal (GI) upset, headache, dizziness, drowsiness, enlarged pupils and disturbances of oculomotorequilibrium and accommodation, dry mouth, and allergic skin reactions
Derm: allergic skin reactions, including sebotropic eruptions, delayed-type hypersensitivity, or urticarial eruption. Chronic use of high doses of kava has also been associated with kava dermopathy, which looks like pellagra but does not respond to niacin
Depression?
Mouth tingling and numbness
Alcohol may potentiate
Kava – precautions, contraindications
CNS depressant interactions
“Concomitant use of kava and alcohol, barbiturates, benzodiazepines, or other
CNS depressants can increase the risk of drowsiness and motor reflex depression” – Risk – high. Levels of evidence – high.